Questions now from the party spokespeople. Plaid Cymru spokesperson, Helen Mary Jones.

Diolch, Llywydd. I wanted to use my first spokesperson's questions to address issues in social care rather than health, as a symbol of how important people across this Chamber, particularly here in our party—. We see health and social care as an equal partnership, not one being more important than the other. So, can I ask the Minister for Social Services: does the Welsh Government know the number of registered nurses and care workers from countries within the EU that are currently working in care homes in Wales, and, if so, what are those figures?

Helen Mary, can I welcome you both to your spokesperson role, but also the way you've just laid out the importance of health and social care in the round? The Brexit stakeholder group that the Cabinet Secretary and I co-chair has looked at this issue. There is a relative paucity of data on the social care sector compared to the health sector. The health sector, we have quite accurate figures on the impact of Brexit, whether it's a 'no deal' or it's some transition, on the workforce within it. So, we have commissioned some work to go off and fill in some of those data gaps, but part of the data gaps is simply because of the wide, varied nature of the care sector. It's not as cohesive as the NHS that we have. But we've commissioned a piece of work to look at that, and, as soon as we are aware of that, I'm sure we will bring it back to the house then to see how we do it. But the reason we're doing it is exactly that: to see how we can prepare for if we are in a situation where we actually have to deal with loss of people from our social care workforce, which is so important for all those people that receive care from people who come to this country from all round the world, quite frankly, to provide care for our citizens.

Thank you for the response, Minister. I'm sure you would understand that, while taking on board what you've said about the complexity of the sector compared to the health sector, it is a source of frustration that we don't know, and, this close to Brexit, that we still don't have—whether you would ever be able to have as comprehensive and accurate a set of figures as we can have for the health service, but it is frustrating that you don't fully know that, and I share your concern, of course, about the potential impact on the workforce of Brexit, and if people are restricted in coming to work here.

Minister, you will be aware of last year's study by the BMJ that links cuts and austerity in social care to an increase in mortality in care homes. One of the mitigating measures, of course, as you will be aware, is the presence of fully qualified registered nurses staffing care home settings. Do you accept that there might be a risk to safety in care homes if Brexit and the immigration rules significantly affect the levels of registered nurses in care homes, and what are you able to do to mitigate that risk?

We absolutely have to guard against that happening. We've made our views very clear to the UK Government, not only in terms of the need for our existing care staff to stay and be welcome here in Wales come what may, but also to avoid tightening up on rules either around the individuals who work in the front line or their families as well, because we have to deal with both. And one of our frustrations at the moment, both the Cabinet Secretary and myself, is that the UK Government is not receptive to our overtures, which we've made in writing, to say, 'It's not good enough to say within health we'll pilot areas where we can have some sort of residency for individuals who are working with health.' That needs to be applied to social care, but it also needs to be applied sympathetically to their families, because why would you stay here, why would you come and work here unless you also know your family is being looked after? So, we are—.

The uncertainty you mentioned, however, is a very fact of the chaos around the Brexit negotiations—the fact that we're at this point over two years after the referendum where we still do not have crystal clarity on what we need to be planning for. But we are now planning, and we have been for some time, with our stakeholders, including with the care inspectorate, the care forum, with providers directly, to say, 'What are the impacts and, even with a complex sector, can we get the most accurate data on what the impact could be, particularly of no deal?' 

Well, thank you, again, Minister. Obviously, nobody's going to blame the Welsh Government for Brexit, but I think it is appropriate that we raise some questions about how long it's taken to get this information, because, of course, there are many other reasons why we ought to have a better and clearer idea of what the skills mix and what the qualifications mix of our social care workforce is. 

Of course, in the previous Assembly, we passed the legislation to create minimum nurse staffing levels in certain hospital settings. Those settings were chosen because there was robust evidence to prove that the levels of the staff nursing had an effect on patient outcomes. We now, of course, have the British Medical Journal study that shows that having qualified nursing staff in care homes can also have a similar impact on mortality and on outcomes. In principle, or on this side of the house, we would support the extension of that legislation ultimately to cover care home settings. We realise that that's aspirational at the moment, but would you commit in principle to considering extending the Act to registered nurses in care home settings, providing the evidence is sufficiently robust in future?

We will always keep our minds open on this, because I think you're right in saying that we always need to go with the evidence. And, of course, only in recent years, we've actually reviewed and renewed the guidance around nursing provision within the care home sector, recognising that, once again, care homes vary significantly in the type of residents they have—whether they need 24-hour cover, et cetera, et cetera. So, we have only fairly recently reviewed and renewed it. But we always keep an open mind about it based on the evidence, as opposed to simply saying, 'Here's a number; if we hit that bottom number, then we provide safe nursing cover within the care sector.' We probably need, if we're going to follow the evidence, also to do it in a very intelligent way that says, because of the quite diverse nursing needs within different care homes, whether those are with elderly infirm patients, whether it's with dementia patients—the differences will be significant. It could be different even from month to month or quarter to quarter, depending on the residents coming through. But I agree on the need to make sure that the evidence tells us what should be safe nursing levels within the care sector, and we'll always keep our minds open to evidence that's brought forward on that. 

Conservative spokesperson—Janet Finch-Saunders. 

Diolch, Llywydd. Minister, I'm sure that you are as horrified as I am to learn of the horrific failings and incidences of alleged abuse and neglect at the Pines residential home in Gwynedd. From the footage that has come to light at this home, there is apparent evidence of falsifying documents, medications hidden in residents' food, unsafe methods of moving residents and an overall lack of dignity and respect in their treatment and care. These are all incidences that fall well below what is expected within Wales and its own care regulations, all highlighted as a result of some investigative journalism shown last night on the Y Byd ar Bedwar S4C programme that I watched. What concerns me, Minister, is that this residential facility was already known to Care Inspectorate Wales and had a number of critical reports against its conduct and treatment of residents, but the poor treatment of its vulnerable adults has clearly continued. What is your Government doing alongside CIW to ensure that any facilities, such as the Pines residential home, are put on strict, meaningful improvement programmes, to ensure that the vulnerable residents are safeguarded against any malpractice or neglect?

Thank you for the question, and yes, I've seen the programme Y Byd ar Bedwar, and we're very aware of the concerns that have been raised regarding the Pines in Criccieth, as is the care inspectorate. The inspectorate took immediate action on being made aware of those issues identified by S4C at the Pines, and its inspection is ongoing as we speak. Now, because of that, it's difficult for me to comment any further about the Pines itself at the moment, but you do rightly point out that, actually, there have been improvement plans and inspections previously that have led to improvement measures within this home. It’s right that the inspectorate is in there right now investigating the latest allegations, as they remain at the moment—allegations—and to see what needs to be done. But it is difficult for me to comment further on the Pines.

What I can say as well, though, is that the care inspectorate carried out over 600 inspections as part of its regular inspection and regulation regime last year, but, of course, it’s always able, on the reporting of any incidents of possible abuse, neglect or whatever, to actually go into a home at a moment’s notice, and that’s what it's done in this respect.

You asked also what can the Welsh Government do further? I think that there are things that we can do and that we are doing. Only a couple of years ago, this Assembly took forward the Regulation and Inspection of Social Care (Wales) Act 2016. That is significantly different, because, for example, that places quite firmly, within law, requirements on providers and designated responsible individuals for care homes so we know where the buck stops as well. But it also moves away from minimum standards of provision, which, if you have a minimum standard, people choose to meet the minimum standard and no more, and it focuses instead on continual improvement, which is what we want to get from all our care home settings. But it also places an emphasis on the importance of the individual—on their care, their support and on supporting them in what their needs are. We won't get there overnight on this, but this is what the Welsh Government can do: set the framework for both the regulator and for care homes to constantly drive improvement.

Thank you. It is vital, however, that any suggestions for improvement, whatever their nature, are taken seriously and that the well-being of vulnerable older people is at the heart of how care is delivered. But my concerns do not just relate to the rights of people within residential homes. As the Welsh Government pursue their 'A Healthier Wales' agenda, which sees more patients receiving care at home, how are you making arrangements to ensure that older people who are receiving care in their own homes can be safe and that they will receive the highest standard of care and that their well-being is supported by all members of the multidisciplinary team responsible for providing that care? The reason I ask that today is that, on Monday, I was shocked by the fact that one of my constituents has recently been very badly let down by the multidisciplinary team that are going into their home at the moment, which has led to their daughter asking for a thorough investigation to what they deem the neglect of their elderly father.

So, what regulations and inspectorate systems will be put in place to ensure that vulnerable adults are not neglected in their own homes? They are some of the most vulnerable members of our society and it is vital that we have an independent inspectorate body in place to visit people in their own homes and ensure that all their needs are being met and their rights respected. What work is taking place, Minister, to ensure that such a system is developed, as your Welsh Government, health boards and social services progress with a community care agenda?

I think, Janet, that there are a number of things that we can do. In fact, when Sarah Rochira left post back in June, I think it was, we stood here in the Senedd and we made that commitment to actually making rights real for older people and we laid out a number of the ways in which we would do that. You’re right in saying this is not simply to do with the care setting: it’s every setting that a person will be in—in their own home, close to home, in a care setting—that makes them have a good quality of life and shows that their rights are respected.

So, some of the practical things that we said: our legislative framework there is underpinned by the Social Services and Well-being (Wales) Act 2016. We said that we would, with the new commissioner, Heléna Herklots, co-produce practical guidance that demonstrates how to make those UN principles real for older people. We would take some of our initial work and focus it on the commissioning of services for older people, on safeguarding in all environments and on advocacy, because these are areas we need to get right if we’re going to support all older people to have voice and control over their health and social care in whatever setting.

But we’re also going to do things within the care home setting as well. So, we will update the 2009 guidance—it’s been too long since we’ve looked at that—in terms of how we escalate concerns about care within care homes. We will take advice from the NHS centre for equality and human rights on how to embed human rights into NHS practice. We will, with Care Inspectorate Wales, build a narrative of human rights into care home inspection reports, in light of the earlier question, and many other aspects. One thing we said we would do with the new commissioner is to ask her to chair a working group for us on making those rights real, because it isn't simply about passing legislation, it's about making them bite. 

Thank you, again. I've met with Heléna Herklots and I was very impressed. I know, going forward, she can't do everything, but one of the things she's going to focus on is elder abuse. The Welsh Conservatives have had long-standing commitments to ensure that the rights of older people in Wales are strengthened, and I am hugely supportive of my own colleague Darren Millar AM who is now bringing forward much needed legislation in this area. We know, Minister, that older people do not always know their rights, they do not always know when an injustice has been committed against them, and they do not always have the confidence to report this. This was most recently evidenced by the Crown Prosecution Service, which revealed that of the 35,000 crimes prosecuted in Wales last year just 250 were against the elderly. It is clear that we need to make a concerted effort to ensure that the rights of older people in Wales are strengthened, that older people know their rights, and public bodies have a duty to promote and to protect these. Can you today acknowledge that there is scope in this area to strengthen this with legislation and that you will work constructively with the proposed Bill, and, of course, those putting it through, to strengthen the rights of our older people here in Wales?

The first thing to say in response is that all rights—older people's, children's rights, the rights of disabled people—are universal and they should be applied in that way. The other thing is I think there is cross-party support for driving the rights agenda as well. I think the question is how we best do that. I'm more than happy to work constructively with Darren and any Member who brings forward suggestions on a rights-based agenda to see whether legislation is the right way forward or whether there are alternative ways. I don't say that latter part of my sentence to row away from, but I think that making rights real is far more than only legislation. That's where, working with commissioners, we can draw out very practical ways for when we talk about older people in care homes, older people who have social care packages in their own homes and so on.

What strikes me is that if I go to a school in Swansea and I ask children about rights, they can articulate to me by the number what those rights are. They can tell me about right 31, the right to play. They can tell me about article 12, the right to be heard and to have grown-ups actually put their ideas in a process. But, if you go to an older person's group and say, 'Do you realise you have rights?', they'll say, 'Really?' So, we've got a way to go.

I'm more than happy to engage constructively on that, because I think we share the same aim. I would simply say in reciprocation, let's engage with it practically on what would be needed to actually make those rights real and make older people aware of the rights that they have, which are universal.

UKIP spokesperson—Gareth Bennett.

Diolch, Llywydd. A couple of weeks ago in the Assembly, I met with representatives from the Alzheimer's Society. During this meeting, I and some of my staff undertook a training and skills session to become dementia friends. The object of becoming a dementia friend is to learn some of the logistics of dementia—what dementia is, what causes is, what are the symptoms. Most importantly, it's designed to demonstrate how we can help people with dementia by better understanding their condition. Cabinet Secretary, could you give us an update on how the Welsh Government is helping to encourage more people to become dementia friendly?

I'm happy to confirm that we work very well with a range of third sector organisations, including those people promoting dementia friends. I've met with Boots, for example, and because of the leadership in Wales, every Boots store in Wales has dementia friends on its staff, and they're looking to roll that out in the rest of the Boots company in other parts of the United Kingdom. Actually, there are lots of people in this room who have undertaken the dementia friends training. I have, as have my staff, and I believe that Jayne Bryant has indicated she wants to try and encourage all of us to be dementia friends, so we can say we're the first legislature in the world that is fully dementia friendly. So, there is much we're doing to promote that campaign being run by one third sector organisation. It's part of actually becoming a dementia friendly nation, which, of course, is spelled out in the Welsh Government's dementia action plan.

Thanks for that answer. That's encouraging to hear. Problems can be caused when people with dementia have to go into hospital, particularly if staff are not trained to meet the needs of those patients. What is the Welsh Government doing to ensure hospital staff at all levels understand how to care for and support people with dementia?

As the Member for Caerphilly will know, I launched the Good Work training toolkit in Ysbyty Ystrad Fawr more than a year ago, and that's been developed by staff within the service working with the third sector so that we do understand the training needs of staff to provide that genuinely person-centred care for people with dementia—to understand what matters to them, to understand how being in an unfamiliar place, for most people, can be unsettling, but particularly for people who have dementia. So, it is absolutely part of where we are within the health service as part of the health contribution to the dementia action plan that we have. But, most importantly, I think, that is being overseen—that whole action plan, not just the training of the staff—. There is genuine engagement with people who are living with dementia in an oversight group for the plan. So, it won't simply be a report back from a Minister, whether it's me or somebody else in the future; you'll have the assurance of people living with dementia giving an honest assessment of where we are in taking forward the commitments we make in that plan. And, of course, we do have a mid-point review, where the public and, indeed, Members of this place can look at what progress we have made and what more we'll still, of course, need to do. 

There can be an additional problem, apart from what we've discussed so far, and that's the problem of stigma surrounding the condition of dementia. Can the Welsh Government do anything to help reduce this stigma surrounding the condition?

I think this conversation, the conversation we've had and regularly have within this place and around it, is part of dealing with that stigma, for people to recognise that more and more people have dementia and will do in the future. It is a society-wide challenge and not something that people need to feel ashamed about at all. The stigma, though, often comes from people not wanting to acknowledge that they have the condition, and their families and carers not always wanting to. And that's difficult because, if you see someone's personality changing in particular, whether that's about a loss of memory or other changes that sometimes happen—because dementia affects different people in different ways—it's, if you like, a basket of potential conditions and outcomes. It can be difficult to accept that person, who you know and who you love, is somebody different in who they are and how they behave, even if they're still the same person who has brought you up, who has loved you and cared for you. And it's very difficult. I know that there are people in this Chamber who have gone through that experience, and outside as well. So, this is a genuine cross-party and cross-society campaign for decency and dignity and having better outcomes for people living with dementia and, of course, the research we will want to undertake to try and improve outcomes and, if at all possible, prevent dementia taking place in the first place. And in that, as with so many other things, we can do more ourselves to make choices that mean that we are less likely to have dementia ourselves in the future.